1. Introduction

1.1. Objectives

  • Demonstrate Central Media Making Laboratory (CMML) activities
  • Define CMML critical needs and inform management
  • Overview of CMML raw material procurement
  • Understand customer request and organize media production as well as media delivery

–> Data of media production, distribution and raw materials were extracted from the Central Media Making Laboratory Management System (CMMLMS) database in comma separated value and imported to the R programming language for cleaning and analysis.

1.2. Background

The Diagnostic Microbiology Development Program (DMDP) has been working with the University of Health Sciences (UHS) in Phnom Penh, Cambodia since 2011 to provide a sustainable source of quality-controlled media such as blood culture broth bottles, agar plates, and media for identification of bacteriological agents. The media is produced and quality controlled by following guidelines for Assuring Quality of Medical Microbiology Culture Media; Clinical and Laboratory Standards Institute and Australian Society for Microbiology 2nd edition to guide development of CMML standard operating procedures and processes. In 2017, DMDP supported the expansion and renovation of premises, purchase and installation of equipment and long-term on-site technical mentoring. Care and bleeding of sheep ensured access to a sustainable source of sheep blood. Since February 2019, CMML has held ISO certification (ISO 9001:2015). The media products were included in the Ministry of Health Essential Medicines List and more than 20 customers purchased media for their routine clinical bacteriology laboratory set up.

2. Raw materials

Data extracted on: 22 Jul 2022
Raw materials are grouped by item name regardless of different brands to discover the current stock. Rows highlighted in pink indicate that the item’s quantity is lower than the threshold.
Note: raw data might not be up to date. It depends on the day data is extracted from CMMLMS in the item batch listing session.

Category Item name Qnt instock Threshold In unit
Antibiotic Azithromycin 15mg 200 50 disk
Cefixime 5mg 200 50 disk
Ceftriaxone 30mg 0 50 disk
Ciprofloxacine 5mg 250 50 disk
colistin 10 1 vial
Cotrimoxazole 25mg 350 50 disk
Gentamicin 10mg 100 50 disk
Tetracycline 30mg 250 50 disk
Consumables 3M attest biological indicator 50 1 box
50ml conic centrifuge tube 20 200 pack
Acetic acid glacial 2,500 1,200 ml
Acohol gel 7 5 unit
Acohol pad 2,000 5 box
Aiway needle 55,000 1,000 box
Aluminum cap BHI bottle 20mm 6,000 10,000 pack
Aluminum foil 10 5 box
Autoclave bag 30x60cm 1,000 500 unit
Autoclave bags 14L 1,400 500 unit
Betadine 2 4 unit
BHI glass bottle 100ml 12,663 8,415 box
BHI glass bottle 50ml 9,740 7,392 box
Blood bag 250ml 155 100 unit
Borosilicate tube 13x100ml 30,000 16,000 box
Buffer solution pH 10.00 250 250 ml
Buffer Solution pH 4.01 250 250 ml
Buffer solution pH 7.00 250 250 ml
CHAM-MATE 24 10 unit
Clear scotch tape 6 5 pack
Conductivity Standard 84uS/cm 500 500 ml
Cotton Swab Sterile 980 400 unit
Cryobox 100 wells 10 5 unit
Crystal Violet 200 25 gram
Glove (?) powdered 100 1,000 unit
Glove (M) powder-free 0 1,000 unit
Glove (S) powder-free 0 1,000 unit
Gram Stain Set (5x500ml) 1 1 kit
Hand towel 8 24 pack
Hydrochloric Acid (HCl) 1,000 500 ml
Junk Label A3 48 20 pack
KimCap 13mm 37,000 16,000 box
Kovacs indole Reagent 0 20 ml
Liquid hand soap 7 10 unit
Loop 10ul 5,100 500 pack
Loop 1ul 4,975 500 pack
Microscope slides 17 2 box
Na - heparinized capillary tube 300 200 box
Needle 21G 1,700 5 box
Neutral Red 75 25 gram
Petri dish 42,000 60,000 unit
Pipette plastic 3ml sterile 500 500 pack
Pipette Tip sterile 1000ul 383 200 pack
Pipette Tip sterile 200ul 288 200 pack
Plastic bag 7x11 73 30 pack
Potassium chloride (KCl) 250 20 ml
Pourite anti-bubble additive 120 120 ml
Rubber stopper BHI 20mm 5,000 12,000 pack
Screw cap plastic tube 12ml 3,250 500 pack
Sodium chloride (NaCl) 1,000 9 gram
Sodium hydroxide (NaOH) 0 100 gram
Sterile screw tube 2ml 2,650 500 pack
Sterilized gauze 6 5 pack
Surgical Mask 650 200 unit
Syringe 10cc 600 200 unit
Syringe 20cc 0 20 unit
Syringe 5cc 500 200 unit
Dehydrated media Amies Transport Medium 205 150 gram
Blood agar base 6,092 1,000 gram
Brain Heart Infusion Broth 9,384 19,000 gram
CLED agar 0 250 gram
GC agar base 2,746 500 gram
Haemoglobin powder 1,092 3,000 gram
Hektoen enteric agar 1,266 1,500 gram
Kligler Iron Agar 1,647 800 gram
Lysine Iron Agar 1,206 500 gram
MacConkey Agar 4,500 10,000 gram
Mannitol Salt Agar 3,066 6,000 gram
Mueller Hinton Broth 500 200 gram
Mueller Hinton II Agar 5,316 12,000 gram
Sabouraud 4% Glucose Agar 500 500 gram
SIM medium 775 250 gram
Simmons Citrate Agar 1,669 250 gram
Soyabean Casein Digest Agar (TSA) 3,908 960 gram
Soyabean Casein Digest Medium (TSB) 5,917 200 gram
TCBS 1,491 1,500 gram
Tryptic Soy Blood Agar Base No 2 9,536 13,000 gram
Tryptic Soy Broth 1,453 200 gram
Trypticase Soy Agar 0 960 gram
Urea agar base 1,292 250 gram
Supplement Crystal Violet 0.1% (in house) 260 50 ml
Gentamicin 80mg 12 1 vial
Glycerol 2,760 1,000 ml
Neutral Red 1% 260 100 ml
Sodium Polyanethole Sulfate (SPS) 373 200 gram
Urea supplement 40% 3,450 400 ml
VCNT supplement 14 50 ml
Vitamino supplement 7,670 3,000 ml
Other Distilled Water 7,306,298 0 ml
Sheep blood 3,655 3,500 ml


Dehydrated media powder is critical for the production of culture media. Based on media production data, we express dehydrated media in grams to determine the consumption.

Abbreviation: ATM-Amies Transport Medium, BAB infusion-Blood agar based infusion, BAB2-Blood agar based No2, BHI-Brain Heart Infusion, CIT-Simmons Citrate agar, CLED-Cystine Lactose Electrolyte Deficient agar, GC-GC agar, HEK-Hektoen Enteric agar, KIA-Kligler Iron agar, LIA-Lysine Iron agar, MAC-MacConkey agar, MHII-Mueller Hinton agar II, MSA- Mannitol Salt agar, MTM-Modified Thayer-Martin agar, SIM-Sulfide Indole Motility, TCBS-Thiosulfate Citrate Bile Salts Sucrose agar, TSA-Tryptic Soy agar, TSB-Tryptic Soy Broth, Urea-Urea agar

3. Sheep Care

Data extracted on: 26 Jul 2022

Sheep blood is a vital supplement to support bacterial growth and to visualize hemolysis patterns. To sustain sheep blood supply for CMML, agreements are established with Resource Development International Cambodia (RDIC) and other sheep farm(s) for care, feeding, bleeding and housing of the sheep. Detail of sheep inventory

Fig 1. Sheep pen Fig 2. Sheep farm

Frequency of sheep blood collection from 01 Jan - 26 Jul 2022:

Sheep ID Sex Farm Frequency
590 Female RDIC 5
739 Male RDIC 5
740 Male RDIC 5
983 Male RDIC 5
993 Female RDIC 5
518 Male RDIC 4
585 Female RDIC 4
593 Female RDIC 4
595 Female RDIC 4
732 Male RDIC 4
985 Female RDIC 4
991 Male RDIC 4
994 Male RDIC 4
998 Male RDIC 4
588 Female EPR 3
981 Male NA 3
990 Female RDIC 3
584 Male RDIC 2
597 Male RDIC 2
600 Male RDIC 2
721 Male NA 2
731 Male NA 2

CMML performs quality control of sheep blood by monitoring packed cell volume (PCV). The acceptable range of PCV for sheep is between 24 to 45. Below is the summary of sheep with PCV out of range, not suitable for blood collection:

Sheep ID Collection Date Farm PCV
999 18 Mar 2022 EPR 23

4. Media Internal Quality Control

Date: 01 Jan - 26 Jul 2022
CMML performs quality control for all batches of media before delivery to customers. The table below summarizes quality control results. Note: experimental media are excluded from this table.

Media name Pass Fail Total
Amies Transport Media 4 0 4
Ashdown’s Agar 12 0 12
Ashdown’s Broth 2 0 2
Blood Agar 53 1 54
Blood Culture Bottle (adult) 52 0 52
Blood Culture Bottle (child) 8 0 8
Chocolate Agar 36 0 36
Cystine Lactose Electrolyte Deficient Agar (CLED) 3 0 3
GC agar +1% growth supplement 6 0 6
Hektoen Enteric Agar 9 0 9
Kligler Iron Agar 10 0 10
Lysine Iron Agar 10 0 10
MacConkey Agar 25 0 25
Mannitol Salt Agar 14 1 15
Modified Thayer-Martin Agar 2 0 2
Mueller Hinton II Agar 32 0 32
Sheep Blood Mueller-Hinton Agar 8 0 8
Simmons Citrate Agar 7 0 7
Sulfide Indole Motility Medium 6 0 6
Thiosulfate Citrate Bile Salts Sucrose Agar (TCBS) 6 0 6
Trypticase Soy Agar 1 0 1
Trypticase Soy Broth 2 0 2
Trypticase Soy Broth + 20% glycerol 4 0 4
Urea Agar 11 0 11
Total 323 ( 99.4 %) 2 ( 0.6 %) 325

5. Media production

We compute media production data from 1 Jan - 19 Jul 2022

6. Media distribution

Media distribution is calculated from 1 Jan - 22 Jul 2022

The bubble in the map shows the different sites of customers orders and the size of the bubble indicates the quantity in units. In cooperation with interactive maps, you can zoom in and click on a map to see data plotting.

Customer Name Jan Feb Mar Apr May Jun Jul Total
Siem Reap 2,100 2,150 1,910 2,230 2,780 4,000 3,100 18,270
Takeo 2,060 0 3,920 0 1,980 3,480 1,630 13,070
Battambang 1,148 730 1,510 1,220 1,020 1,550 2,410 9,588
Kossamak 740 840 900 1,190 1,340 1,400 1,680 8,090
KSFH 790 0 1,680 790 1,510 1,310 860 6,940
Kampong Cham 900 650 810 1,310 590 1,240 880 6,380
NPHL 600 1,110 150 440 1,380 0 860 4,540
BOM 470 810 1,000 950 710 10 160 4,110
Sunrise Hospital 540 630 130 540 500 450 260 3,050
BTB_AFRIMS 200 260 410 840 160 550 607 3,027
SHCH 791 309 200 200 520 450 449 2,919
Biobykin 250 280 310 190 230 350 290 1,900
National Pediatric Hospital 304 0 0 103 497 300 500 1,704
Amatak Laboratory 214 0 120 80 0 130 80 624
CMML 40 0 290 27 99 71 10 537
Svay Rieng 0 270 0 0 0 180 0 450
Pro Laboratory 120 0 70 0 70 0 90 350
International Standard lab 150 0 150 0 0 0 0 300
Royal Phnom Penh hospital 270 0 0 0 0 0 0 270
Olympia Medical Hub 0 0 0 0 190 0 0 190
US NAMRU-2 0 0 110 0 0 0 0 110
Central Laboratory 0 0 0 0 0 0 110 110
Urology clinic 50 0 0 30 0 0 0 80
Gold Medical Diagnostic Laboratory 0 0 50 0 0 0 0 50
American University of Phnom penh 0 0 0 0 0 30 0 30
NPHL: National Public Health Laboratory,
BOM: Blue Opportunity Medical Co.,Ltd.,
NHealth Laboratory: Royal Phnom Penh hospital’s laboratory,
DDL: Diagnostic and Detection Laboratory,
KSFH: Khmer Soviet Friendship Hospital,
SHCH: Sihanouk Hospital Center of Hope

From the start of the year, CMML distributed quality controlled media to different groups of customers around the country. Customers are classified in four groups:
1. Government laboratory supported by DMDP: Siem Reap, Battambang, Kampong Cham, Takeo and National Public Health Laboratory
2. Government laboratory supported by project: e.g AMR surveillance, stool project in Battambang
3. Government laboratory purchased: interestingly with an increase in orders from government laboratories e.g Khmer Soviet Friendship Hospital, Cambodia China Friendship Hospital (Kossamak), National Pediatric Hospital,…
4. Private laboratory purchased: e.g Royal Phnom Penh hospital department of laboratory, International Laboratory, Dynamic pharma…. 5. Supplier purchased: supplier purchase media from CMML and sell to laboratories. e.g BOM, Dynamic…

We summarized quantity and cost in USD for the DMDP supported laboratory by month for routine diagnostic testing.

Cusomter Name Media Type Jan Feb Mar Apr May Jun Jul
Battambang Adult Bottle 200 (344$) 0 390 (671$) 340 (585$) 150 (258$) 230 (396$) 500 (860$)
Child Bottle 88 (143$) 0 90 (146$) 20 (32$) 40 (65$) 50 (81$) 150 (243$)
Plate 860 (882$) 580 (622$) 620 (659$) 520 (533$) 590 (612$) 890 (921$) 1490 (1499$)
Tube 0 150 (128$) 410 (347$) 340 (294$) 240 (206$) 380 (325$) 270 (230$)
Kampong Cham Adult Bottle 0 0 150 (258$) 100 (172$) 0 150 (258$) 50 (86$)
Child Bottle 50 (81$) 50 (81$) 50 (81$) 100 (162$) 0 50 (81$) 50 (81$)
Plate 550 (565$) 600 (608$) 610 (627$) 810 (836$) 490 (498$) 680 (701$) 580 (599$)
Tube 300 (247$) 0 0 300 (247$) 100 (85$) 360 (294$) 200 (161$)
NPHL Adult Bottle 0 0 0 10 (17$) 20 (34$) 0 10 (17$)
Child Bottle 0 0 0 10 (16$) 10 (16$) 0 0
Plate 470 (456$) 860 (800$) 150 (161$) 270 (261$) 1000 (946$) 0 700 (639$)
Tube 130 (108$) 250 (175$) 0 150 (109$) 350 (260$) 0 150 (109$)
Siem Reap Adult Bottle 300 (516$) 400 (688$) 300 (516$) 450 (774$) 600 (1032$) 500 (860$) 500 (860$)
Child Bottle 50 (81$) 0 50 (81$) 50 (81$) 50 (81$) 50 (81$) 0
Plate 1250 (1266$) 1230 (1243$) 1310 (1405$) 1480 (1553$) 1860 (1893$) 2640 (2688$) 1850 (1861$)
Tube 500 (427$) 520 (442$) 250 (214$) 250 (214$) 270 (234$) 810 (688$) 750 (641$)
Takeo Adult Bottle 200 (344$) 0 550 (946$) 0 350 (602$) 350 (602$) 350 (602$)
Child Bottle 100 (162$) 0 200 (324$) 0 120 (194$) 150 (243$) 100 (162$)
Plate 1190 (1226$) 0 2330 (2445$) 0 1230 (1274$) 1960 (1893$) 1080 (1194$)
Tube 570 (456$) 0 840 (683$) 0 280 (236$) 1020 (830$) 100 (66$)
NPHL: routine sample

Reported by CMML


26-Jul-2022